Ocular hypertension Intraocular pressure

Intraocular pressure (lOP) To lower lOP in patients with open-angle glaucoma or ocular hypertension. 

Elevated intraocular pressure f/OPJ Treatment of elevated lOP in patients with ocular hypertension or open-angle glaucoma. 

Elevated intraocular pressure (lOP) For reduction of elevated lOP in patients with open-angle glaucoma and ocular hypertension who are intolerant of other lOP-lowering medications or insufficiently responsive to another lOP-lowering medication. 

Blockers can reduce intraocular pressure in glaucoma and ocular hypertension. The mechanism is believed to be related to a decreased production of aqueous humor. 

Blockers can be used topically to reduce intraocular pressure in patients with chronic open-angle glaucoma and ocular hypertension. The mechanism by which ocular pressure is reduced appears to depend on decreased production of aqueous humor. Timolol has a somewhat greater ocular hypotensive effect than do the available cholinomimetic or adrenomimetic drugs. The 3-blockers also are beneficial in the treatment of acute angle-closure glaucoma. 

Other reported side effects include vomiting, salivation, lacrimation, shivering, skin rash, and an interaction with thyroid preparations that may lead to hypertension and tachycardia. Ketamine also may raise intracranial pressure and elevate pulmonary vascular resistance, especially in children with trauma or congenital heart disease. Increases in intraocular pressure also may occur, and vigilance is required if ketamine is used in ocular surgery. 

Glucocorticoids induce cataract formation, particularly in patients with rheumatoid arthritis. An increase in intraocular pressure related to a decreased outflow of aqueous humor is also a frequent side effect of periocular, topical, or systemic administration. Induction of ocular hypertension, which occurs in about 35% of the general population after glucocorticoid administration, depends on the specific drug, the dose, the frequency of administration, and the glucocorticoid responsiveness of the patient. 

The effects of topical dexamethasone on intraocular pressure have been compared with those of fluorometho-lone (SEDA-22, 446 66). The ocular hypertensive response to topical dexamethasone in children occurs more often, more severely, and more rapidly than that reported in adults. It should be avoided in children if possible and it is desirable to monitor the intraocular pressure when it is being used. Fluorometholone may be more acceptable. 

The cannabinoids tested so far appear to be of limited use in the treatment of glaucoma. They appear to act only against a primary (but not sole) symptom of the disease (i.e., ocular hypertension), rather than against the underlying disease process, which remains uncertain. The side-effects of those cannabinoids particularly effective in lowering intraocular pressure (IOP) restrict their clinical usefulness (with some exceptions such as canna-bigerol). Cannabinoids administered intraocularly to humans cause no IOP reduction. ... 

Figure 10-1 Effect of latanoprost 0.005% applied once daily at 8 00 pm and timolol 0.5% applied twice daily at 8 00 am and 8 00 PM on intraocular pressure (lOP) as determined at 8 00 am (12 hours after last dose) in patients with ocular hypertension or glaucoma. Asterisks signify a significant further reduction of lOP by latanoprost compared with timolol. (Adapted from Camras CB. Comparison of latanoprost and timolol in patients with ocular hypertension and glaucoma. Ophthalmology 1996 103 138-147.)...

Figure 10-15 Mean intraocular pressure (lOP) change (mm Hg) for the various treatment groups by visit and time of day for a 3-month treatment period. Each value represents the least-squares mean of the change from baseline diurnal lOP, and all were significant. (Adapted from Silver LH, Brinzolamide Primary Therapy Smdy Group. Clinical efficacy and safety of brinzolamide [Azopt], a new topical carbonic anhydrase inhibitor for primary open-angle glaucoma and ocular hypertension. Am J Ophthalmol 1998 126 400-408.)...

Chiba T, Kashiwagi K, Chiba N, Tsukahara S. Effect of nonsteroidal anti-inflammatory ophthalmic solution on intraocular pressure reduction by latanoprost in patients with primary open angle glaucoma or ocular hypertension. Br J Ophthalmol 2006 90 314-317. 

The ocular side effects of corticosteroids are many and are related to the route of administration. The most common concerns are increased intraocular pressure (lOP) and cataracts, but delayed epithelial woimd healing and increased risk of infection due to immime modulation and decreased tear lysozyme levels are issues for the cornea. Changes to other ocular tissues have been noted (subconjunctival hemorrhages, blue sclera, eyelid hyperemia and edema, retinal emboUc events, central serous choroidopathy) and neurologic compUcations reported (diplopia, nerve palsies, intracranial hypertension) (see Appendix 35-1). 

Note OADRs = ocular adverse drug reactions CV = color vision VF = visual field VL = vision loss NFL = nerve fiber layer lOP = intraocular pressure NSAIDs = nonsteroidal anti-inflammatory drugs TBUT = tear break-up time CL = contact lens IH = intracranial hypertension RD = retinal detachment NAION = nonarteritic ischemic optic neuropathy. 

E. U Keats and R. Stone, "The effect of D-timoiol on intraocular pressure in patients with ocular hypertension," Am. /. Ophtalmol., 98 73-78 (1984). 

The ocular hypertensive response in this case could have been due to systemic absorption of glucocorticoid through the skin of the eyelid, especially when there was a surgical wound. Alternatively, a sufficient amount of ointment could have seeped over the eyelid margins, causing the rise in intraocular pressure, similar to the application of eye-drops, as has been reported in another child, who also had Cushing s syndrome, a rare result of ophthalmic glucocorticoids (370). 

Indications Reduction of elevated intraocular pressure in open angle glaucoma and ocular hypertension. 

Inclusion criteria for patients enrolled in the study included severe uveitis with posterior segment involvement with or without iridocyclitis, previous favorable response to oral or periocular corticosteroids, treatment-limiting side effects associated with systemic or periocular corticosteroids or systemic nonsteroidal immunosuppressive agents, intraocular pressure controlled at <21 mmHg with no more than one anti-ocular hypertensive drop and ability to attend follow-up visits. In total, seven eyes of five patients were included and the patients had a diagnosis of Bechet s syndrome or idiopathic panuveitis. The mean uveitis duration before device implantation was six years and the mean visual acuity was 20/207. 

Dorzolamide is a carbonic anhydrase inhibitor that inhibits carbonic anhydrase enzyme, reducing the rate of aqueous humor formation and thus lowering intraocular pressure (lOP). It is indicated in the treatment of elevated lOP in patients with ocular hypertension or open-angle glaucoma. 

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